血管性痴呆危险因素分析及血浆生长抑素和内皮素对其诊断价值

发布时间：2018-01-27 10:17

本文关键词： 脑梗死血管性痴呆血浆生长抑素内皮素诊断价值　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过检测血管性痴呆(Va D)患者血浆生长抑素(SS)和内皮素(ET)水平,探讨血浆SS和ET与Va D的关系,判断血浆SS和ET对Va D的诊断价值,并探讨脑梗死后Va D的危险因素,为Va D早期预防和诊断提供依据。方法收集2015年1月-2016年12月宁夏人民医院神经内科住院的脑梗死后3个月患者作为研究对象,所选对象符合中华医学会神经病学分会制定的《中国急性缺血性脑卒中诊疗指南2014》的诊断标准。根据MMSE和Mo CA量表及相应的纳入标准将患者进行分组,其中脑梗死后Va D组46例,脑梗死非痴呆组(N-Va D)42例;对照组(30例)选择同期在性别、年龄、文化程度上无统计学差异的体检者。记录所有纳入对象的一般情况,分析Va D主要危险因素;采用放射免疫法测定患者血浆SS和ET-1的浓度,探讨血浆SS和ET-1对Va D的诊断价值。结果(1)Va D组、N-Va D组和对照组在年龄、性别和文化程度上无统计学差异(P0.05),具有可比性;Va D组患者Mo CA评分和MMSE评分均低于N-Va D组和对照组,差异均有统计学意义(P0.01)。(2)Va D组患者高血压病、糖尿病和冠心病的发生率高于N-Va D组,差异有统计学意义(P0.05),两组在高脂血症、吸烟及饮酒史方面无统计学差异(P0.05);多因素回归分析显示高血压病(OR=3.694,P=0.025)和糖尿病(OR=2.922,P=0.040)是Va D的主要危险因素。(3)Va D组患者血浆SS浓度为(104.83±18.67ng/L)明显低于N-Va D组(138.36±11.19ng/L)和对照组(149.47±7.01ng/L),三组比较差异均有统计学意义(P0.01);Va D组患者血浆ET-1浓度(85.76±6.75 pg/ml)显著高于N-Va D组(72.95±7.72pg/ml)和对照组(62.37±6.34pg/ml),三组比较差异均有统计学意义(P0.01)。(4)Va D组中(轻、中、重度)各组血浆SS水平随着痴呆严重程度的加重而降低,ET-1水平随着痴呆严重程度的加重而增高,差异均有统计学意义(P0.01)。(5)经Spearman相关性分析,血浆SS与MMSE评分成正相关(r=0.473,P0.01);血浆ET-1与MMSE评分存在负相关(r=-0.438,P0.01)。结论(1)高血压病和糖尿病是Va D的主要危险因素。(2)Va D患者血浆SS水平降低,血浆ET-1水平增高,且血浆SS和ET-1水平与痴呆程度有关,血浆SS水平越低,ET-1水平越高,对Va D的诊断价值越大。
[Abstract]:Objective to investigate the relationship between plasma SS, et and Vad by detecting plasma somatostatin (SS) and endothelin (et) levels in patients with vascular dementia (VD). To evaluate the diagnostic value of plasma SS and et in patients with Vad and to explore the risk factors of Vad after cerebral infarction. Methods from January 2015 to December 2016, three months after cerebral infarction in Department of Neurology, Ningxia people's Hospital, were selected as the study objects. The selected subjects were in accordance with the diagnostic criteria of the guidelines for the diagnosis and treatment of Acute Ischemic Stroke in China developed by the Neurology Branch of the Chinese Medical Association. According to MMSE and Mo. Patients were grouped with CA scale and corresponding inclusion criteria. There were 46 cases of Va D group and 42 cases of N-Va D group after cerebral infarction. In the control group (30 cases), the subjects who had no statistical difference in sex, age and education level were selected. The general situation of all the subjects was recorded and the main risk factors of Vad were analyzed. The plasma levels of SS and ET-1 were measured by radioimmunoassay, and the diagnostic value of plasma SS and ET-1 in Vad was discussed. There was no significant difference in age, sex and education between N-Va D group and control group (P 0.05). The scores of MoCA and MMSE in group Va D were lower than those in group N-Va D and control group, and the difference was statistically significant (P 0.01). The incidence of diabetes mellitus and coronary heart disease was higher than that of N-Va D group (P 0.05). There was no significant difference in hyperlipidemia, smoking and drinking history between the two groups. Multivariate regression analysis showed that hypertension was 3.694% (P < 0.025) and diabetes mellitus was 2.922 (P < 0.05). Plasma SS concentration in Va D group was 104.83 卤18.67 ng / L, which was significantly lower than that in N-Va D group (P < 0.05). 138.36 卤11.19ng / L) and control group (149.47 卤7.01ng / L). The differences among the three groups were statistically significant (P 0.01). The plasma ET-1 concentration of Va-D group was 85.76 卤6.75 PG / ml, significantly higher than that of N-Va-D group (72.95 卤7.72 PG / ml) and control group (P < 0.05). 62.37 卤6.34 PG / ml. There were significant differences among the three groups in plasma SS levels in the middle (light, medium and severe) groups with the severity of dementia. The level of ET-1 increased with the aggravation of the severity of dementia, and the difference was statistically significant (P 0.01. 05) by Spearman correlation analysis. There was a positive correlation between plasma SS and MMSE score. There was a negative correlation between plasma ET-1 and MMSE score. Conclusion: hypertension and diabetes mellitus are the main risk factors of VAD. Plasma SS level is lower and plasma ET-1 level is higher in patients with VAD. The levels of SS and ET-1 were related to the degree of dementia. The lower the level of SS and the higher the level of ET-1, the greater the diagnostic value of VAD.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.13

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